Provider Demographics
NPI:1932338811
Name:NELSON, KARL (PHD, LCAC)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:
Last Name:NELSON
Suffix:
Gender:M
Credentials:PHD, LCAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383-5719
Mailing Address - Country:US
Mailing Address - Phone:219-477-5524
Mailing Address - Fax:
Practice Address - Street 1:601 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-5719
Practice Address - Country:US
Practice Address - Phone:219-477-5524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20041990A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical